‘Choosing Wisely’: a growing international campaign

Levinson, Wendy; Kallewaard, Marjon; Bhatia, R. Sacha; Wolfson, Daniel; Shortt, Sam; Kerr, Eve A.

doi:10.1136/bmjqs-2014-003821

Cited by 489 publications

(391 citation statements)

References 15 publications

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“…2,3 Of interest for health policy makers, payers and clinicians are current utiliza tion rates for the procedures mentioned in these recommendations. Establishing baseline rates permits an understanding of the extent of the problem of lowvalue care, which in turn allows monitoring of the effect of initiatives such as Choosing Wisely on utilization rates over time.…”

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Preoperative testing before low-risk surgical procedures

Kirkham

Wijeysundera

Pendrith

et al. 2015

CMAJ

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) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%-2.9%) and 2.1% (95% CI 2.1%-2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66-75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6-19.0; for radiography, adjusted OR 2.9, 95% CI 2.8-3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5-8.8; for radiography, adjusted OR 2.2, 95% CI 2.1-2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7-6.9; for radiog raphy, adjusted OR 3.6, 95% CI 3.5-3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively.Interpretation: Despite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient-and institutionlevel factors. AbstractCMAJ Podcasts: author interview at soundcloud.com/cmajpodcasts/150174res

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Preoperative testing before low-risk surgical procedures

Kirkham

Wijeysundera

Pendrith

et al. 2015

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“…We present the results of a 2-year process, involving a broad coalition of 25 Although the majority of lists address issues in adult medicine, the AAP, the Society of Hospital Medicine (represented by its Pediatric Choosing Wisely Committee), and the American College of Rheumatology (Pediatric Rheumatology) have also participated. 26,27 Newborn medicine offers special challenges to the Choosing Wisely approach.…”

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confidence: 99%

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value

et al. 2015

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BACKGROUND: The use of unnecessary tests and treatments contributes to health care waste. The “Choosing Wisely” campaign charges medical societies with identifying such items. This report describes the identification of 5 tests and treatments in newborn medicine. METHODS: A national survey identified candidate tests and treatments. An expert panel of 51 individuals representing 28 perinatal care organizations narrowed the list over 3 rounds of a modified Delphi process. In the final round, the panel was provided with Grading of Recommendation, Assessment, Development and Evaluation (GRADE) literature summaries of the top 12 tests and treatments. RESULTS: A total of 1648 candidate tests and 1222 treatments were suggested by 1047 survey respondents. After 3 Delphi rounds, the expert panel achieved consensus on the following top 5 items: (1) avoid routine use of antireflux medications for treatment of symptomatic gastroesophageal reflux disease or for treatment of apnea and desaturation in preterm infants, (2) avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection, (3) avoid routine use of pneumograms for predischarge assessment of ongoing and/or prolonged apnea of prematurity, (4) avoid routine daily chest radiographs without an indication for intubated infants, and (5) avoid routine screening term-equivalent or discharge brain MRIs in preterm infants. CONCLUSIONS: The Choosing Wisely Top Five for newborn medicine highlights tests and treatments that cannot be adequately justified on the basis of efficacy, safety, or cost. This list serves as a starting point for quality improvement efforts to optimize both clinical outcomes and resource utilization in newborn care.

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“…Amazingly, you can't even find out which companies' treks are more or less expensive, or which of the treks that your insurer will cover! Overuse of medical services is a major problem in wealthy countries (especially in the United States, but also in Canada), [1][2][3] and contributes not only to skyrocketing expenditures, but also to major medical harm because of false-positive test findings, incidentalomas, and overdiagnosis. [4][5][6] At the same time, overuse may crowd out spending for needed medical services, 7 contributing to the parallel problem of underuseparticularly for those who most need such care such as the poor and those with chronic illnesses.…”

Section: Paul Atkinsonmentioning

confidence: 99%